Ophthalmic instrument

ABSTRACT

An ophthalmic instrument is provided for removing vitreous and fibrous bands from the retina of an eye. The instrument consists of two tubes mounted coaxially within one another, and with an opening adjacent the end of the outer tube. Cutting of the vitreous and fibrous bands is performed by a chopping action set up by the sharp end of the inner tube against the inner surface of the end of the outer tube. The vitreous and fibrous bands which are trapped in the mouth of the instrument are chopped and removed by suction by way of the inner tube. In the instrument to be described, the vitreous is replaced continuously by a saline solution, for example, which is introduced into the instrument by way of a small infusion tube.

United States Patent [1 1 Peyman et al. 4, 1973 [54] OPHTHALMICINSTRUMENT 3,526,219 9/1970 Balamuth 128/305 X [75] Inventors: Gholam A.Peyman, Chicago, In; 3,628,522 12/1971 Kato 128/305 X 1 Nicholas A.DOdiCh, Marina Del FQREIGN PATENTS'OR APPLICATIONS y Calif- 437,93211/1926 Germany 128 305 [73] Assignee: The Regents of the University ofC lif i B k l C lm Primary Examiner-Channing L. Pace Att W T. .1 t 1. 22Filed: Aug. 24, 1971 omey essup a 1 pp 174,349 57 ABSTRACT An ophthalmicinstrument is provided for removing [52] US. Cl. 128/305, 294/15vitreous and fibrous bands from the retina of an eye. Cl A61! A61b17/32, A6 m U The instrument consists of two tubes mounted coaxi- [58]Field of Search 128/305; 269/81; ll within one another, and with anopening adjacent 19 R the end of the outer tube. Cutting of the vitreousand fibrous bands is perfonned by a chopping action set [56] R fll sCited up by the sharp end of the inner tube against the inner UNITEDSTATES PATENTS surface of the end of the outer tube. The vitreous and3,606,878 9 1971 Kellogg, Jr 128/305 x hhrous bands which are trapped inthe h the 3,614,953 10 1971 Moss 128/305 Instrument are pp and removed ysuctlon y 3,618,611 11/1971 Urban.. 128/305 way of the inner tube. Inthe instrument to be de- 975,727 11/1910 Smith 294/19 R X scribed, thevitreous is replaced continuously by a sa- 1.076,97l 1913 g 0 UX linesolution, for example, which is introduced into the 1,677,209 7/ 1928Rose 128/305 X instrument by way of a small infusion tube. 2,714,8908/1955 Vang... 128/305 2,721,555 lO/l955 Jenney 128/305 3 Claims, 5Drawing Figures DOG Om/ fey/0690mm 542 4 OPHTHALMIC INSTRUMENTBACKGROUND OF THE INVENTION Many diseases of theblood vessels of theretina cause massive hemorrhage into the vitreous. This hemorrhage ispartly re-absorbed, but organized to a large extent as fibrous bands,and these can reduce the vision to blindness by pulling on the retina orpreventing light to pass through it. t

The role of vitreous in retinal detachment has been recognized for manyyears. But the vitreous remained more or less untouched until Shafer1958) replaced it with human vitreous implant. (D. M. Shafer, TheTreatment of Retinal Detachment by Vitreous Implant. TransactionsAmerican Academy 1 Ophthalmology. Otolaryng. 61:194-200, 1958). Later,Michaelson described in 1960 an instrument capable of cutting thevitreous bands. (Michaelson, Transcleral Division of Mid-VitreousMembrane UnderVisual Control, British Journal of Ophthalmology,44:634-635, 1960). Cibis in 1964 replaced the vitreous with silicon anddevised instruments for cutting the vitreous bands. (P. A. Cibis,Vitreous Transfer and Silicon Injection Transactions American AcademyOphthalmology Oto-laryng. 68:983-997, 1964). Freeman, Schepens, andAnastopoulous introduced their vitreous scissors in 1967 (VitreousSurgery 11 Instrumentation and Technique Arch. Ophthal. 77:681-682,1967). Kasner reported onVitrectomy in 1968 (D. Kasner Vitrectomy: A NewApproach to the Management of Vitreous Highlights Ophthal. 11:304-309,1968 (published in July 1969)). More recently, Machamer, Buettner andNorton in 1970 developed a vitreous cutter-sucker infusion instrument(Vitrectomy-American Academy Ophthalmology and Otolaryng. Las Vegas1970).

Because of the nature of vitreous, which is composed of hyaloronic acidand collogen fiber, it is'not possible simply to remove the substance bysuction and to replace it with a balanced saline solution. The vitreousmust be incised. Thus far, the available instruments have been plainscissors, as described in the aforesaid publication by Freeman et al.,and the aforesaid instrument devised by Machemer et 211.; as describedin the above identified publication of the American Academy ofOphthalmology and Otolaryng.

The Machamer et al. instrument consists of two tubes mounted coaxiallywith one another and with a hole in both tubes. The inner tube of theMachamer et al. instrument rotates against the inner surface of theouter tube at one or two rotations per second. However, the Machamer etal instrument does not provide satisfac tory results because therotation of the inner tube ends to cause shearing and traction on thecollogen fiber, which result in a pulling effect and a tendency toinjure the retina.

The instrument of the present invention is intended to overcome thedeficiencies of the prior art instruments, and to provide a moreefficient means for removing the vitreous and fibrous bands, this beingachieved by sucking out the substances and incising the fiber, theinstrument acting as a tissue chopper, as will be described. Therapidity by which the instrument of the invention can chop the collogenfiber can reach a speed of fifty times per second. The instrument of theinvention has a feature in that there is no pulling or shearing of thecollogen fibers of the vitreous. The instrument can also be used for theremoval of the eye lens by incising and sucking out the lens material.

Specifically, the instrument of the invention, as described brieflyabove, consists of .two tubes mounted coaxially within one another, theouter tube having a closed end with an opening adjacent its closed end.The inner tube is driven by electromagnetic means so that it movesreciprocally within the outer tube. The cutting of the vitreous isperformed within the instrument by a chopping motion. The sharp end ofthe inner tube repeatedly strikes the base plate at the end of the outertube. The vitreous andfibrous bands which are trapped in the mouth ofthe instrument are chopped and removed by suction by way of the innertube. As mentioned above, there is no pulling or shearing effect on thefibrous bands or on the vitreous fibers. As also mentioned above, thevitreous is replaced continuously by the instrument of the invention bya saline solution which is introduced into the eye through theinstrument by a small infusion tube.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is an elevational view of anophthalmic instrument constructed to represent one embodiment of theinvention, the instrument of FIG. 1 being shown in conjunction with amanipulator which allows the surgeon to move the instrument in anydesired direction, as will be described;

FIG. 2 is a side section of the instrument of FIG. 1;

FIG. 3 is a side section, like FIG. 2, but of merely a fragment of theinstrument, to show the components thereof in an operating positiondifferent from that shown in FIG. 2;

FIG. 4 is a somewhat schematic representation of appropriate apparatusfor providing suction to the instrument of FIG. 1, and also forproviding a replacement fluid for introduction into the eye as theoperation progresses; and i FIG. 5 is a fragmentary schematicrepresentation of the instrument'of FIG. 1, and showing the manner inwhich the instrument cuts and removes the vitreous substance. I

DETAILED DESCRIPTIONDF THE ILLUSTRATED.

EMBODIMENT I suction tube 14 extends through the plunger 12b, with theplunger being affixed to the tube 14, so that as the plunger is movedrapidly up and down due to the successive energizing and deenergizing ofthe solenoid, the tube 14 also moves rapidly up and down.

The tube 14 is coaxial with a further tube 16, the latter tube extendingdown from the lower part of the housing 10. The outer tube 16 forms atubular housing for the inner tube 14. The lower end of the outer tube16 is closed by means, for example, by a plate 18, an opening 20 beingprovided in the wall of the outer tube adjacent the plate 18, as shown.The lower end of the inner tube 14 has a cutting surface formed on it asdesignated 14a. In a constructed embodiment, for example, the inner tubehad an outer diameter of 1.2 millimeters, whereas the tubular housing 16had an outer diameter of L5 millimeters.

The tube 14 is coupled, for example, by means of a flexible suction tube24 to an appropriate vacuum source. The representation of FIG. 2 showsthe inner tube 14 in a position in which the spring 120 causes itscutting end 14a to be displaced away from the inner surface of the plate18. In the view of FIG. 3, however, the solenoid is energized, so thatthe cutting surface of the inner tube 14 is moved down against the innersurface of the plate 18.

As best shown in FIG. 5, the representation A shows the vitreoussubstance being drawn in through the opening adjacent the lower endplate 18 of the outer tube 16. In the'representation A, the inner tube14 is displaced up from the inner surface of the end plate 18, and therepresentation A corresponds to the representation of FIG. 2. In FIG. 5,the representation B is similar to that of FIG. 3, in which the lowertube 14 is moved down, so that its cutting surface coacts with the innerface of the end plate 18, and a portion of the vitreous substance istrapped within the center tube, as shown. In the representation C ofFIG. 5, the severed portion of the vitreous substance is drawn upwardlythrough the inner tube 14 by suction.

As mentioned above, the vitreous in the eye is replaced continuously bya saline solution which is introduced into the eye by way of a smallinfusion tube 30, the infusion tube having a diameter, for example, ofthe order of 0.3 millimeters. The infusion tube is fastened to the sideof the outer tube 16, as shown in FIGS, 2, 3 and 5, for example. Theinfusion tube 30 is coupled to a source of thesaline solution by way,for example, of a flexible tube 32.

The saline solution may be supplied to the infusion tube 30 by means ofthe apparatus shown in FIG. 4 and, at the same time, a suction may beestablished in the inner tube 14 by the same apparatus. The aparatusshown in FIG. 4 comprises essentially two syringes 50 and 52 which aremounted in axial alignment with one antoher, and which are operated by acommon plunger 54. The flexible tube 32 is coupled to the syringe 52, asshown, whereas the flexible tube 24 is coupled to the syringe 50.

-A bracket 56 (FIG. 4) on the common plunger 54 is coupled by way of aline 58 to a take-up spool 60, the take-up spool being operated, forexample, by an electric motor 62. As the motor is energized, it causesthe spool 60 to rotate, which, in turn, causes the line 58 slowly todraw the common plunger 54 to the left in FIG. 4. The syringe 52constitutes the source of the saline solution which is introduced to.theinfusion tube 30 by way of the flexible tube 32. To that end, thesyringe52 is filled with the appropriate saline replacement solution. As theplunger 54 moves to the left, it forces an appropriate replacementsolution out of the syringe 52 and through the flexible lead 32 to theinfusion tube 30. The syringe 50, on the other hand, constitutes thevacuum source for the flexible suction tube 24. At the same time, thecommon plunger establishes a suction through the flexible lead 24, sothat the inner tube 14 may perform its desired function.

The instrument, as shown in FIG. 1, may be held by the surgeon in amanipulator 61, the manipulator being any desired inclination, and setit at that inclination. The manipulator may be attached to the operatingtable, for example, and it can be adjusted to have any desired angularposition prior to the operation.

Any appropriate electrical circuit may be provided for driving thesolenoid 12 at a desired rate.

To remove and replace the vitreous substance, the solenoid 12 isactivated by an intermittent electric current which causes the innertubular member 14 to move back and forth within the tubular housing 16,as the solenoid is energized and deenergized. As described above, foreach downward stroke of the inner tubular member 14, its cutting endincises and traps a portion of the vitreous substance drawn into thetubular housing through the opening 20, and this substance is drawnupwardly through the tube 14 by the suction exerted by the apparatus ofFIG. 3.

As the vitreous body is cut and drawn through the inner tubular member14, it is replaced with appropriate replacement fluid which is fed tothe eye through the tubular member 30. The apparatus is adjusted to thatthe amount of fibrous substance removed and the amount replaced by thereplacement fluid is always equal. The removing and replacing of thevitreous body is accomplished by the apparatus of FIG. 4 in the mannerdescribed above. The apparatus of FIG. 4 permits equal removal andreplacement of the eye fluid, thereby maintaining the correct pressurewithin the eye.

As mentioned above, the instrument of the invention can also be used forlens removal from the eye. When used for such a purpose, the opening 20in the tubular housing 16 is made larger than the opening used forvitreous removal. The reason for this is that the lens, being of a moresolid and curved configuration, will fit more easily into the enlarged.opening for cutting and removal by suction by the instrument of theinvention.

The instrument described above has been used successfully, and has beenfound to perform with a high degree of efficiency in performing itsintended function. The instrument may be operated at high speed, andthere is no pulling or shearing effect on the fibrous bands or vitreoussubstance. The instrument also provides, as described, for the vitreousin the eye to be replaced continuously by an appropriate replacementsolution, such as saline. The instrument is easy to manipulate insidethe vitreous. Moreover, the instrument may be produced at a relativelylow cost.

While a particular embodiment of the invention has been shown anddescribed, modifications may be made. For example, the outer diameter ofthe instrument can be made smaller than 15 millimeters; the instrumentcan be equipped with optic fibers for illumination within the eye; theinstruments tip can be made very flat, and the inner tube can be made asa flat blade for cutting the membrane close to the surface of theretina. It is intended to cover in the following claims all equippedwith a ball joint 63 through which the tubular housing 16 of theinstrument protrudes. By holding the manipulator, the surgeon can turnthe instrument to modifications which come within the spirit and scopeof the invention.

What is claimed is:

i 1. An ophthalmic instrument for re-ceiving vitreous, lens, and thelike, from the eye, said instrument including:

an elongated tubular housing having an open end and a closed end, andhaving an opening in the side wall thereof adjacent said closed end;

a tubular member mounted coaxially within said tubular housing insliding contact with the inner surface of said tubular housing andextending through the open end thereof, said tubular member providing apassage for the vitreous material, and the like, to remove such materialfrom the interior of said tubular housing, and said tubular memberhaving an annular cutting edge facing said closed end of said tubularhousing;

electrically actuated means for producing relative axial movementbetween said tubular housing and said tubular member whereby saidtubular member incises substances drawn into said opening in saidtubular housing;

means coupling said tubular member to a suction pressure source to drawthe incised substances from said housing up through said tubular member;

said manipulator having a ball joint therein through which said tubularhousing protrudes, so as to permit positioning of the instrument at anydesired angular position.

1. An ophthalmic instrument for re-ceiving vitreous, lens, and the like,from the eye, said instrument including: an elongated tubular housinghaving an open end and a closed end, and having an opening in the sidewall thereof adjacent said closed end; a tubular member mountedcoaxially within said tubular housing in sliding contact with the innersurface of said tubular housing and extending through the open endthereof, said tubular member providing a passage for the vitreousmaterial, and the like, to remove such material from the interior ofsaid tubular housing, and said tubular member having an annular cuttingedge facing said closed end of said tubular housing; electricallyactuated means for producing relative axial movement between saidtubular housing and said tubular member whereby said tubular memberincises substances drawn into said opening in said tubular housing;means coupling said tubular member to a suction pressure source to drawthe inciSed substances from said housing up through said tubular member;and an infusion tube mounted externally on said tubular housing forintroducing a replacement fluid into the eye during the operation of theinstrument, when the tubular housing is inserted into the eye, tomaintain constant pressure within the eye.
 2. The combination defined inclaim 1, and which includes further means coupling said infusion tube toa pressurized source of replacement fluid.
 3. The instrument defined inclaim 1, and which includes a manipulator for supporting the instrument,said manipulator having a ball joint therein through which said tubularhousing protrudes, so as to permit positioning of the instrument at anydesired angular position.